Part 8-1 Cardiovascular Pharmacology

Question 1

Cardiovascular meds

Answer 1

Largest area of pharmacology

Meds often “wear several hats” and have multiple implications

Question 2

Diuretics

Answer 2

Act on kidneys: increase sodium and water excretion

Decrease fluid in vascular system

Question 3

Diuretics Indications

Answer 3

Hypertension

Congestive Heart Failure

Question 4

Diuretics Examples

Answer 4

Thiazides
Loop Diuretics
Potassium sparing agents

Question 5

Diuretics Adverse effects

Answer 5

Fluid depletion; electrolyte imbalance
Watch for:
-orthostatic hypotension
-weakness, fatigue
-confusion, mood changes

Question 6

Beta Blockers

Answer 6

• Bind to heart to block effects of epinephrine and NE
• Decreased HR & contraction force
• Can also produce general decrease in sympathetic response

Question 7

Beta blockers indications

Answer 7

Hypertension
Angine
Arrhythmias
Heart Failure
Recovery from MI
Migraines
Raynauds
Situational Anxiety

Question 8

Common beta blockers

Answer 8

“olol” suffix

Cardioselective and Nonselective

Question 9

Cardioselective beta blockers

Answer 9

Atenolol
Metoprolol
Others

Question 10

Nonselective beta blockers

Answer 10

Pindolol
Propranolol
Others

Question 11

Beta Blockers adverse effects

Answer 11

Bronchoconstriction
Decreased maximal exercise capacity
Orthostatic hypotension
Psychotropic effects

Question 12

Sympatholytic effect

Answer 12

A general decrease in sympathetic responses

Question 13

Other sympatholytic antihypertensives

Answer 13

• Alpha blockers
• Presynaptic adrenergic inhibitors
• Centrally acting agents
• Ganglionic blockers

Question 14

Vasodilators

Answer 14

Act directly on vascular smooth muscle…inhibit contraction

Question 15

Vasodilators indications

Answer 15

Hypertension

Heart failure

Question 16

Vasodilators adverse effects

Answer 16

Reflex tachycardia
Orthostatic hypotension
Dizziness, headaches
Edema, fluid retention
Avoid systemic heat

Question 17

Renin-angiotensin system

Answer 17

Neuroendocrine response that helps control BP and other physiological reactions in various tissues

Question 18

People with excessive RAS responses have….

Answer 18

Increased blood pressure
Damage to CV system
Damage to kidneys

Question 19

Options to prevent harmful effects of Angiotensin II

Answer 19

1. ACE inhibitors
2. Angiotensin II receptor blockers
3. Direct renin inhibitors

Question 20

Angiotension converting enzyme inhibitors (ACE)

Answer 20

Inhibit angiotensin converting enzyme

Decrease formation of angiotensin II

Question 21

ACE inhibitors effects

Answer 21

Decrease BP and long term heart and BV effects

Question 22

ACE inhibitor indications

Answer 22

Hypertension

Heart failure

Question 23

Ang-II receptor blockers

Answer 23

• Block Ang-II receptors
• Prevent detrimental effects of Ang II
• May be as effective as ACE inhibitors but fewer side effects

Question 24

Direct renin inhibitors

Answer 24

Aliskiren: inhibits renin’s ability to convert Angiotensinogen to Ang I

Question 25

RAS drugs adverse effects

Answer 25

Well tolerated, some nausea and dizziness Possible allergic reactions ACE inhibitors cause dry cough

Question 26

Calcium channel blockers

Answer 26

- Limit calcium entry into vascular smooth muscle and cardiac muscle - Promote vasodilation, stabilize HR

Question 27

Calcium channel blockers indications

Answer 27

Hypertension Angina pectoris Arrythmias

Question 28

Calcium channel blocker examples

Answer 28

"ipine" drugs

Question 29

CCBs adverse effects

Answer 29

``` Swelling in feet, ankles Orthostatic hypotension Altered heart rate Avoid systemic heat Increased risk of heart attack ```

Question 30

Organic Nitrates

Answer 30

Nitroglycerin, isosorbide dinatrate

Question 31

Organic nitrate route of administration

Answer 31

Sublingual traditionally | Creams or patches transdermal

Question 32

Organic nitrates primary indication

Answer 32

Angina pectoris

Question 33

Nitrates primary effects

Answer 33

Dilate peripheral vasculature | Decrease cardiac workload and O2 demand

Question 34

Venous dilation causes...

Answer 34

Decreased cardiac preload | Blood returning to heart

Question 35

Arterial dilation causes...

Answer 35

Decreased cardiac afterload | Pressure heart pumps against

Question 36

Nitroglycerin onset and duration

Answer 36

Sublingual: 1-3 min onset 30-60 min duration Patches: 40-60 min 8-24 hr

Question 37

Isosorbide dinitrate onset and duration

Answer 37

Oral: 20-40 min onset 4-6 hr duration Sublingual: 2-5 min onset 1-2 hr duration

Question 38

Isosorbide mononitrate onset and duration

Answer 38

Oral: 30-60 min onset 6-8 hour duration

Question 39

Amyl nitrate onset and duration

Answer 39

Inhaled: 30 sec onset 5-10 min duration

Question 40

Nitrate tolerance

Answer 40

Continuous adminstration reduces drug effects | Effectiveness restored quickly when nitrates are discontinued

Question 41

Prevention of nitrate tolerance

Answer 41

Daily nitrate-free intervals | Patch 12 hr on/12 hr off

Question 42

Nitrates adverse effects

Answer 42

``` Headaches/Dizziness Orthostatic hypotension Increased vasodilation Sublingual doses: -check drug viability -have drug ready before rehab ```

Question 43

Digitalis

Answer 43

Group of agents derived from foxglove plant -Digitalis glycosides Used for congestive hart failure

Question 44

Digitalis mechanical effects

Answer 44

-Inhibits Na-K pump in cardiac cells; accumulates Na in cell -Increases intracellular Ca2+ -Increased actin-myosin binding (Stronger cardiac contraction)

Question 45

Digitalis Autonomic effects

Answer 45

Decreased HR by: - stimulating vagus - inhibiting sympathetics to heart

Question 46

Digitalis Toxicity

Answer 46

- Relatively common 20-25% hospitalized patients on digitalis - Can be fatal

Question 47

Digitalis toxicity common symptoms

Answer 47

``` GI distress Fatigue Confusion Depression Blurred Vision Arrhythmias ```

Question 48

Positive inotropes

Answer 48

Acute or severe heart failure - phosphodiesterase inhibitors - Dopamine, Dobutamine

Question 49

Phosphodiesterase inhibitors

Answer 49

Increase myocardial Ca by preventing Camp breakdown

Question 50

Dopamine/Doputamine

Answer 50

Stimulate beta-1 receptors

Question 51

Positive inotropes limitations

Answer 51

- Parenteral administration - Not more effective than digitalis - Typically used in acute or severe heart failure